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On Injuries of the Head 
By Hippocrates 

Translated by Francis Adams 


Men's heads are by no means all like to one another, nor are the 
sutures of the head of all men constructed in the same form. Thus, 
whoever has a prominence in the anterior part of the head (by prominence 
is meant the round protuberant part of the bone which projects beyond 
the rest of it) , in him the sutures of the head take the form of the 
Greek letter tau, T; for the head has the shorter line running transverse 
before the prominence, while the other line runs through the middle 
of the head, all the way to the neck. But whoever has the prominence 
in the back part of the head, in him the sutures are constructed in 
quite the opposite form to the former; for in this case the shorter 
line runs in front of the prominence, while the longer runs through 
the middle all along to the forehead. But whoever has a prominence 
of the head both before and behind, in him the sutures resemble the 
Greek letter eta E; for the long lines of the letter run transverse 
before each prominence while the short one runs through the middle 
and terminates in the long lines. But whoever has no prominence on 
either part he has the sutures of the head resembling the Greek letter 
chi; for the one line comes transverse to the temple while the other 
passes along the middle of the head. The bone at the middle of the 
head is double, the hardest and most compact part being the upper 
portion, where it is connected with the skin, and the lowest, where 
it is connected with the meninx (dura mater) ; and from the uppermost 
and lowermost parts the bone gradually becomes softer and less compact, 
till you come to the diploe. The diploe is the most porous, the softest, 
and most cavernous part. But the whole bone of the head, with the 
exception of a small portion of the uppermost and lowermost portions 
of it, is like a sponge; and the bone has in it many juicy substances, 
like caruncles; and if one will rub them with the fingers, some blood 
will issue from them. There are also in the bone certain very slender 
and hollow vessels full of blood. So it is with regard to hardness, 
softness, and porosity. 


In respect to thickness and thinness; the thinnest and weakest part 
of the whole head is the part about the bregma; and the bone there 
has the smallest and thinnest covering of flesh upon it, and the largest 
proportion of brain is situated in that region of the head. And hence 
it happens that from similar or even smaller wounds and instruments, 
when a person is wounded to the same or a less degree, the bone of 
the head there is more contused, fractured, and depressed; and that 
injuries there are more deadly and more difficult to cure; and it 
is more difficult to save one's life in injuries there than in any 
other part of the head; that from having sustained a similar or even 
a less wound a man will die, and that, too, in a shorter space of 
time than from a wound in any other part of the head. For the brain 
about the bregma feels more quickly and strongly any mischief that 
may occur to the flesh or the bone; for the brain about the bregma 
is in largest quantity, and is covered by the thinnest bone and the 
least flesh. Of the other portions, the weakest is that about the 
temples; for it is the conjunction of the lower jaw with the cranium, 
and there is motion there up and down as at a joint; and the organ 

of hearing is near it; and further, a hollow and important vein runs 
along the temple. But the whole bone of the head behind the vertex 
and the ear is stronger than the whole anterior part, and the bone 
itself has a larger and deeper covering of flesh upon it. And hence 
it follows, that when exposed to the same or even greater injuries 
from instruments of the same or greater size, the bone is less liable 
to be fractured and depressed than elsewhere; and that in a fatal 
accident the patient will live longer when the wound is in the posterior 
part of the head than when elsewhere; and that pus takes longer time 
to form and penetrate through the bone to the brain, owing to the 
thickness of the bone; and moreover, as there is less brain in that 
part of the head, more persons who are wounded in the back part of 
the head escape than of those who wounded in the anterior part. And 
in fatal cases, a man will survive longer in winter than in summer, 
whatever be the part of the head in which the wound is situated. 


As to the haedrae (dints or marks?) of sharp and light weapons, when 
they take place in the bone without fissure, contusion, or depression 
inwards (and these take place equally in the anterior and posterior 
part of the head) , death, when it does occur, does not properly result 
from them. A suture appearing in a wound, when the bone is laid bare, 
on whatever part of the head the wound may have been inflicted, is 
the weakest point of the head to resist a blow or a weapon, when the 
weapon happens to be impinged into the suture itself; but more especially 
when this occurs in the bregma at the weakest part of the head, and 
the sutures happen to be situated near the wound, and the weapon has 
hit the sutures themselves . 


The bone in the head is liable to in the following modes, and there 
are many varieties in each of these modes of fracture: When a wounded 
bone breaks, in the bone comprehending the fissure, contusion necessarily 
takes place where the bone is broken; for an instrument that breaks 
the bone occasions a contusion thereof more or less, both at the fracture 
and in the parts of the bone surrounding the fracture. This is the 
first mode. But there are all possible varieties of fissures; for 
some of them are fine, and so very fine that they cannot be discovered, 
either immediately after the injury, or during the period in which 
it would be of use to the patient if this could be ascertained. And 
some of these fissures are thicker and wider, certain of them being 
very wide. And some of them extend to a greater, and some to a smaller, 
distance. And some are more straight, nay, completely straight; and 
some are more curved, and that in a remarkable degree. And some are 
deep, so as to extend downwards and through the whole bone; and some 
are less so, and do not penetrate through the whole bone. 


But a bone may be contused, and yet remain in its natural condition 
without any fracture in it; this is the second mode. And there are 
many varieties of contusion; for they occur to a greater or less degree, 
and to a greater depth, so as sometimes to extend through the whole 
bone; or to a less depth, so as not to extend through the whole bone; 
and to a greater and smaller length and breadth. But it is not possible 
to recognize any of these varieties by the sight, so as to determine 

their form and extent; neither, indeed, is it visible to the eyes 
when any mischief of this kind takes place, and immediately after 
the injury, whether or not the bone has been actually bruised, as 
is likewise the case with certain fractures at a distance from the 
seat of injury. 


And the bone being fractured, is sometimes depressed inwards from 
its natural level along with the fractures, otherwise there would 
be no depression; for the depressed portion being fractured and broken 
off, is pushed inwards, while the rest of the bone remains in its 
natural position; and in this manner a fracture is combined with the 
depression. This is the third mode. There are many varieties of depression, 
for it may comprehend a greater and a small extent of bone, and may 
either be to a greater depth, or less so, and more superficial. 


When a hedra, or dint of a weapon, takes place in a bone, there may 

be a fracture combined with it; and provided there be a fracture, 

contusion must necessarily be joined, to a greater or less extent, 

in the seat of the dint and fracture, and in the bone which comprehends 

them. This is the fourth mode. And there may be a hedra, or indentation 

of the bone, along with contusion of the surrounding bone, but without 

any fracture either in the hedra or in the contusion inflicted by 

the weapon. But the indentation of a weapon takes place in a bone, 

and is called hedra, when the bone remaining in its natural state, 

the weapon which struck against the bone leaves its impression on 

the part which it struck. In each of these modes there are many varieties, 

with regard to the contusion and fracture, if both these be combined 

with the hedra, or if contusion alone, as it has been already stated 

that there are many varieties of contusion and fracture. And the hedra, 

or dint, of itself may be longer and shorter, crooked, straight, and 

circular; and there are many varieties of this mode, according to 

the shape of the weapon; and they may be more or less deep, and narrower 

or broader, and extremely broad. When a part is cleft, the cleft or 

notch which occurs in the bone, to whatever length or breadth, is 

a hedra, if the other bones comprehending the cleft remain in their 

natural position, and be not driven inwards; for in this case it would 

be a depression, and no longer a hedra. 


A bone may be injured in a different part of the head from that on 
which the person has received the wound, and the bone has been laid 
bare. This is the fifth mode. And for this misfortune, when it occurs, 
there is no remedy; for when this mischief takes place, there is no 
means of ascertaining by any examination whether or not it has occurred, 
or on what part of the head. 


Of these modes of fracture, the following require trepanning: the 
contusion, whether the bone be laid bare or not; and the fissure, 
whether apparent or not. And if, when an indentation (hedra) by a 

weapon takes place in a bone it be attended with fracture and contusion, 
and even if contusion alone, without fracture, be combined with the 
indentation, it requires trepanning. A bone depressed from position 
rarely requires trepanning; and those which are most pressed and broken 
require trepanning the least; neither does an indentation (hedra) 
without fracture and contusion require trepanning; nor does a notch, 
provided it is large and wide; for a notch and a hedra are the same. 

PART 10 

In the first place, one must examine the wounded person, in what part 
of the head the wound is situated, whether in the stronger or weaker 
parts; and ascertain respecting the hairs about the wound, whether 
they have been cut off by the instrument, and have gone into the wound; 
and if so, one should declare that the bone runs the risk of being 
denuded of flesh, and of having sustained some injury from the weapon. 
These things one should say from a distant inspection, and before 
laying a hand on the man; but on a close examination one should endeavor 
to ascertain clearly whether the bone be denuded of flesh or not; 
and if the denuded bone be visible to the eyes, this will be enough; 
but otherwise an otherwise an examination must be made with the sound. 
And if you find the bone denuded of the flesh, and not safe from the 
wound, you must first ascertain the state of the bone, and the extent 
of the mischief, and of what assistance it stands in need. One should 
also inquire of the wounded person how and in what way he sustained 
the injury; and if it be not apparent whether the bone has sustained 
an injury or not, it will be still more necessary, provided the bone 
be denuded, to make inquiry how the wound occurred, and in what manner; 
for when contusions and fractures exist in the bone, but are not apparent, 
we must ascertain, in the first place from the patient's answers, 
whether or not the bone has sustained any such injuries, and then 
find out the nature of the case by word and deed, with the exception 
of sounding. For sounding does not discover to us whether the bone 
has sustained any of these injuries or not; but sounding discovers 
to us an indentation inflicted by a weapon, and whether a bone be 
depressed from its natural position, and whether the bone be strongly 
fractured; all which may also be ascertained visibly with the eyes. 

PART 11 

And a bone sustains fractures, either so fine as to escape the sight, 

or such as are apparent, and contusions which are not apparent, and 

depression from its natural position, especially when one person is 

intentionally wounded by another, or when, whether intentionally or 

not, a blow or stroke is received from an elevated place, and if the 

instrument in the hand, whether used in throwing or striking, be of 

a powerful nature, and if a stronger person wound a weaker. Of those 

who are wounded in the parts about the bone, or in the bone itself, 

by a fall, he who falls from a very high place upon a very hard and 

blunt object is in most danger of sustaining a fracture and contusion 

of the bone, and of having it depressed from its natural position; 

whereas he that falls upon more level ground, and upon a softer object, 

is likely to suffer less injury in the bone, or it may not be injured 

at all. Of those instruments which, falling upon the head, wound the 

parts about the bone, or the bone itself, that which falls from a 

very high place, and the least on a level with the person struck, 

and which is at the same time very hard, very blunt, and very heavy, 

and which is the least light, sharp, and soft, such an instrument 

would occasion a fracture and contusion of the bone. And there is 

most danger that the bone may sustain these injuries, under such circumstances. 

when the wound is direct and perpendicular to the bone, whether struck 
from the hand or from a throw, or when any object falls upon the person, 
or when he is wounded by falling, or in whatever way the bone sustains 
a direct wound from this instrument. Those weapons which graze the 
bone obliquely are less apt to fracture, contuse, or depress the bone, 
even when the bone is denuded of flesh; for in some of those wounds 
thus inflicted the bone is not laid bare of the flesh. Those instruments 
more especially produce fractures in the bone, whether apparent or 
not, and contusions, and inward depression of the bone, which are 
rounded, globular, smooth on all sides, blunt, heavy, and hard; and 
such weapons bruise, compress, and pound the flesh; and the wounds 
inflicted by such instruments, whether obliquely or circularly, are 
round, and are more disposed to suppurate, and to have a discharge, 
and take longer time to become clean; for the flesh which has been 
bruised and pounded must necessarily suppurate and slough away. But 
weapons of an oblong form, being, for the most part, slender, sharp, 
and light, penetrate the flesh rather than bruise it, and the bone 
in like manner; and such an instrument may occasion a hedra and a 
cut (for a hedra and a cut are same thing) ; but weapons of this description 
do not produce contusions, nor fractures, nor depressions inwardly. 
And in addition the appearances in the bone, which you call detect 
by the sight, you should make inquiry as to all these particulars 
(for they are symptoms of a greater or less injury), whether the wounded 
person was stunned, and whether darkness was diffused over his eyes, 
and whether he had vertigo, and fell to the ground. 

PART 12 

When the bone happens to be denuded of flesh by the weapon, and when 

the wound occurs upon the sutures, it is difficult to distinguish 

the indentation (hedra) of a weapon which is clearly recognized in 

other parts of the bone, whether it exist or not, and especially if 

the hedra be seated in the sutures themselves . For the suture being 

rougher than the rest of the bone occasions confusion, and it is not 

clear which is the suture, and which the mark inflicted by the instrument, 

unless the latter (hedra) be large. Fracture also for the most part 

is combined with the indentation when it occurs in the sutures; and 

this fracture is more difficult to discern when the bone is broken, 

on this account, that if there be a fracture, it is situated for the 

most part in the suture. For the bone is liable to be broken and slackened 

there, owing to the natural weakness of the bone there, and to its 

porosity, and from the suture being readily ruptured and slackened: 

but the other bones which surround the suture remain unbroken, because 

they are stronger than the suture. For the fracture which occurs at 

the suture is also a slackening of the suture, and it is not easy 

to detect whether the bone be broken and slackened by the indentation 

of a weapon occurring in the suture, or from a contusion of the bone 

at the sutures; but it is still more difficult to detect a fracture 

connected with contusion. For the sutures, having the appearance of 

fissures, elude the discernment and sight of the physician, as being 

rougher than the rest of the bone, unless the bone be strongly cut 

and slackened (for a cut and a hedra are the same thing) . But it is 

necessary, if the wound has occurred at the sutures, and the weapon 

has impinged on the bone or the parts about it, to pay attention and 

find out what injury the bone has sustained. For a person wounded 

to the same, or a much smaller, extent, and by weapons of the same 

size and quality, and even much less, will sustain a much greater 

injury, provided he has received the blow at the sutures, than if 

it was elsewhere. And many of these require trepanning, but you must 

not apply the trepan to the sutures themselves, but on the adjoining 

bone . 

PART 13 

And with regard to the cure of wounds in the head, and the mode of 
detecting injuries in the bone which are not apparent, the following 
is my opinion:- In a wound of the head, you must not apply anything 
liquid, not even wine, but as little as possible, nor a cataplasm, 
nor conduct the treatment with tents, nor apply a bandage to an ulcer 
on the head, unless it be situated on the forehead, in the part which 
is bare of hairs, or about the eyebrow and eye, for wounds occurring 
there require cataplasms and bandages more than upon any other part 
of the head. For the rest of the head surrounds the whole forehead, 
and the wounds wherever situated become inflamed and swelled, owing 
to an influx of blood from surrounding parts. And neither must you 
apply cataplasms and bandages to the forehead at all times; but when 
the inflammation is stopped and the swelling has subsided, you must 
give up the cataplasms and bandages. A wound in any other part of 
the head must not be treated with tents, bandages, or cataplasms, 
unless it also requires incision. You must perform incision on wounds 
situated on the head and forehead, whenever the bone is denuded of 
flesh, and appears to have sustained some injury from the blow, but 
the wound has not sufficient length and breadth for the inspection 
of the bone, so that it may be seen whether it has received any mischief 
from the blow, and of what nature the injury is, and to what extent 
the flesh has been contused, and whether the bone has sustained any 
injury, or whether it be uninjured by the blow, and has suffered no 
mischief; and with regard to the treatment, what the wound, and the 
flesh, and the injury of the bone stand in need of. Ulcers of this 
description stand in need of incision; and, if the bone be denuded 
of the flesh, and if it be hollow, and extend far obliquely, we cut 
up the cavity wherever the medicine cannot penetrate readily, whatever 
medicine it may be; and wounds which are more inclined to be circular 
and hollow, and for the most part others of the like shape, are cut 
up by making double incision in the circle lengthways,, according 
to the figure of the man, so as to make the wound of a long form. 
Incisions may be practiced with impunity on other parts of the head, 
with the exception of the temple and the parts above it, where there 
is a vein that runs across the temple, in which region an incision 
is not to be made. For convulsions seize on a person who has been 
thus treated; and if the incision be on the left temple, the convulsions 
seize on the right side; and if the incision be on the right side, 
the convulsions take place on the left side. 

PART 14 

When, then, you lay open a wound in the head on account of the bones 
having been denuded of the flesh, as wishing to ascertain whether 
or not the bone has received an injury from the blow, you must make 
an incision proportionate to the size of the wound, and as much as 
shall be judged necessary. And in making the incision you must separate 
the flesh from the bone where it is united to the membrane (pericranium?) 
and to the bone, and then fill the whole wound with a tent, which 
will expand the wound very wide next day with as little pain as possible; 
and along with the tents apply a cataplasm, consisting of a mass (maza) 
of fine flour pounded in vinegar, or boiled so as to render it as 
glutinous as possible. On the next day, when you remove the tent, 
having examined the bone to see what injury it has sustained, if the 
wound in the bone be not right seen by you, nor can you discover what 
mischief the bone itself has sustained, but the instrument seems to 
have penetrated to the bone so as to have injured it, you must scrape 
the bone with a raspatory to a depth and length proportionate to the 

suture of the patient, and again in a transverse direction, for the 

sake of the fractures which are not seen, and of the contusions which 

are not discovered, as not being accompanied with depression of the 

bone from its natural position. For the scraping discovers the mischief, 

if the injuries in the bone be not otherwise manifest. And if you 

perceive an indentation (hedra) left in the bone by the blow, you 

must scrape the dint itself and the surrounding bones, lest, as often 

happens, there should be a fracture and contusion, or a contusion 

alone, combined with the dint, and escape observation. And when you 

scrape the bone with the raspatory, and it appears that the wound 

in the bone requires the operation, you must not postpone it for three 

days, but do it during this period, more especially if the weather 

be hot, and you have had the management of the treatment from commencement. 

If you suspect that the bone is broken or contused, or has sustained 

both these injuries, having formed your judgement from the severity 

of the wound, and from the information of the patient, as that the 

person who inflicted the wound, provided it was done by another person, 

was remarkably strong, and that the weapon by which he was wounded 

was of a dangerous description, and then that the man had been seized 

with vertigo, dimness of vision, and stupor, and fell to the ground, - 

under these circumstances, if you cannot discover whether the bone 

be broken, contused, or both the one and the other, nor can see the 

truth of the matter, you must dissolve the jet-black ointment, and 

fill the wound with it when this dissolved, and apply a linen rag 

smeared with oil, and then a cataplasm of the maza with a bandage; 

and on the next day, having cleaned out the wound, scrape the bone 

with the raspatory. And if the bone is not sound, but fractured and 

contused, the rest of it which is scraped will be white; but the fracture 

and contusion, having imbibed the preparation, will appear black, 

while the rest of the bone is white. And you must again scrape more 

deeply the fracture where it appears black; and, if you thus remove 

the fissure, and cause it to disappear, you may conclude that there 

has been a contusion of the bone to a greater or less extent, which 

has occasioned the fracture that has disappeared under the raspatory; 

but it is less dangerous, and a matter of less consequence, when the 

fissure has been effaced. But if the fracture extend deep, and do 

not seem likely to disappear when scraped, such an accident requires 

trepanning. But having performed this operation, you must apply the 

other treatment to the wound. 

PART 15 

You must be upon your guard lest the bone sustain any injury from 
the fleshy parts if not properly treated. When the bone has been sawed 
and otherwise denuded, whether it be actually sound, or only appears 
to be so, but has sustained some injury from the blow, there may be 
danger of its suppurating (although it would not otherwise have done 
so) , if the flesh which surrounds the bone be ill cured, and become 
inflamed and strangled; for it gets into a febrile state, and becomes 
much inflamed. For the bone acquires heat and inflammation from the 
surrounding flesh, along with irritation and throbbing, and the other 
mischiefs which are in the flesh itself, and from these it gets into 
a state of suppuration. It is a bad thing for the flesh (granulations?) 
in an ulcer to be moist and mouldy, and to require a long time to 
become clean. But the wound should be made to suppurate as quickly 
as possible; for, thus the parts surrounding the wound would be the 
least disposed to inflammation, and would become the soonest clean; 
for the flesh which has been chopped and bruised by the blow, must 
necessarily suppurate and slough away. But when cleaned the wound 
must be dried, for thus the wound will most speedily become whole, 
when flesh devoid of humors grows up, and thus there will be no fungous 
flesh in the sore. The same thing applies to the membrane which surrounds 

the brain: for when, by sawing the bone, and removing it from the 
meninx, you lay the latter bare, you must make it clean and dry as 
quickly as possible, lest being in a moist state for a considerable 
time, it become soaked therewith and swelled; for when these things 
occur, there is danger of its mortifying. 

PART 16 

A piece of bone that must separate from the rest of the bone, in consequence 

of a wound in the head, either from the indentation (hedra) of a blow 

in the bone, or from the bone being otherwise denuded for a long time, 

separates mostly by becoming exsanguous . For the bone becomes dried 

up and loses its blood by time and a multiplicity of medicines which 

are used; and the separation will take place most quickly, if one 

having cleaned the wound as quickly as possible will next dry it, 

and the piece of bone, whether larger or smaller. For a piece of bone 

which is quickly dried and converted, as it were, into a shell, is 

most readily separated from the rest of the bone which retains its 

blood and vitality; for, the part having become exsanguous and dry, 

more readily drops off from that which retains its blood and is alive. 

PART 17 

Such pieces of bone as are depressed from their natural position, 
either being broken off or chopped off to a considerable extent, are 
attended with less danger, provided the membrane he safe; and bones 
which are broken by numerous and broader fractures are still less 
dangerous and more easily extracted. And you must not trepan any of 
them, nor run any risks in attempting to extract the pieces of bone, 
until they rise up of their own accord, upon the subsidence of the 
swelling. They rise up when the flesh (granulations) grows below, 
and it grows from the diploe of the bone, and from the sound portion, 
provided the upper table alone be in a state of necrosis. And the 
flesh will shoot up and grow below the more quickly, and the pieces 
of bone ascend, if one will get the wound to suppurate and make it 
clean as quickly as possible. And when both the tables of the bone 
are driven in upon the membrane, I mean the upper and lower, the wound, 
if treated in the same way, will very soon get well, and the depressed 
bones will quickly rise up. 

PART 18 

The bones of children are thinner and softer, for this reason, that 
they contain more blood [than those of adults]; and they are porous 
and spongy, and neither dense nor hard. And when wounded to a similar 
or inferior degree by weapons of the same or even of an inferior power, 
the bone of a young person more readily and quickly suppurates, and 
that in less time than the bone of an older person; and in accidents, 
which are to prove fatal, the younger person will die sooner than 
the elder. But if the bone is laid bare of flesh, one must attend 
and try to find out, what even is not obvious to the sight, and discover 
whether the bone be broken and contused, or only contused; and if, 
when there is an indentation in the bone, whether contusion, or fracture, 
or both be joined to it; and if the bone has sustained any of these 
injuries, we must give issue to the blood by perforating the bone 
with a small trepan, observing the greatest precautions, for the bone 
of young persons is thinner and more superficial than that of elder 
persons . 

PART 19 

When a person has sustained a mortal wound on the head, which cannot 

be cured, nor his life preserved, you may form an opinion of his approaching 

dissolution, and foretell what is to happen from the following symptoms 

which such a person experiences. When a bone is broken, or cleft, 

or contused, or otherwise injured, and when by mistake it has not 

been discovered, and neither the raspatory nor trepan has been applied 

as required, but the case has been neglected as if the bone were sound, 

fever will generally come on if in winter, and in summer the fever 

usually seizes after seven days. And when this happens, the wound 

loses its color, and the inflammation dies in it; and it becomes glutinous, 

and appears like a pickle, being of a tawny and somewhat livid color; 

and the bone then begins to sphacelate, and turns black where it was 

white before, and at last becomes pale and blanched. But when suppuration 

is fairly established in it, small blisters form on the tongue and 

he dies delirious. And, for the most part, convulsions seize the other 

side of the body; for, if the wound be situated on the left side, 

the convulsions will seize the right side of the body; or if the wound 

be on the right side of the head, the convulsion attacks the left 

side of the body. And some become apoplectic. And thus they die before 

the end of seven days, if in summer; and before fourteen, if in winter. 

And these symptoms indicate, in the same manner, whether the wound 

be older or more recent. But if you perceive that fever is coming 

on, and that any of these symptoms accompany it, you must not put 

off, but having sawed the bone to the membrane (meninx) , or scraped 

it with a raspatory (and it is then easily sawed or scraped) , you 

must apply the other treatment as may seem proper, attention being 

paid to circumstances. 


When in any wound of the head, whether the man has been trepanned 

or not, but the bone has been laid bare, a red and erysipelatous swelling 

supervenes in the face, and in both eyes, or in either of them, and 

if the swelling be painful to the touch, and if fever and rigor come 

on, and if the wound look well, whether as regards the flesh or the 

bone, and if the parts surrounding the wound be well, except the swelling 

in the face, and if the swelling be not connected with any error in 

the regimen, you must purge the bowels in such a case with a medicine 

which will evacuate bile; and when thus purged the fever goes off, 

the swelling subsides, and the patient gets well. In giving the medicine 

you must pay attention to the strength of the patient. 

PART 21 

With regard to trepanning, when there is a necessity for it, the following 

particulars should be known. If you have had the management of the 

case from the first, you must not at once saw the bone down to the 

meninx; for it is not proper that the membrane should be laid bare 

and exposed to injuries for a length of time, as in the end it may 

become it may become fungous. And and there is another danger if you 

saw the bone down to the meninx and remove it at once, lest in the 

act of sawing you should wound the meninx. But in trepanning, when 

only a very little of the bone remains to be sawed through, and the 

bone can be moved, you must desist from sawing, and leave the bone 

to fall out of itself. For to a bone not sawed through, and where 

a portion is left of the sawing, no mischief can happen; for the portion 

now left is sufficiently thin. In other respects you must conduct 

the treatment as may appear suitable to the wound. And in trepanning 

you must frequently remove the trepan, on account of the heat in the 

bone, and plunge it in cold water. For the trepan being heated by 

running round, and heating and drying the bone, burns it and makes 

a larger piece of bone around the sawing to drop off, than would otherwise 

do. And if you wish to saw at once down to the membrane, and then 

remove the bone, you must also, in like manner, frequently take out 

the trepan and dip it in cold water. But if you have not charge of 

the treatment from the first, but undertake it from another after 

a time, you must saw the bone at once down to the meninx with a serrated 

trepan, and in doing so must frequently take out the trepan and examine 

with a sound (specillum), and otherwise along the tract of the instrument. 

For the bone is much sooner sawn through, provided there be matter 

below it and in it, and it often happens that the bone is more superficial, 

especially if the wound is situated in that part of the head where 

the bone is rather thinner than in other parts. But you must take 

care where you apply the trepan, and see that you do so only where 

it appears to be particularly thick, and having fixed the instrument 

there, that you frequently make examinations and endeavor by moving 

the bone to bring it up. Having removed it, you must apply the other 

suitable remedies to the wound. And if, when you have the management 

of the treatment from the first, you wish to saw through the bone 

at once, and remove it from the membrane, you must, in like manner, 

examine the tract of the instrument frequently with the sound, and 

see that it is fixed on the thickest part of the bone, and endeavor 

to remove the bone by moving it about. But if you use a perforator 

(trepan?), you must not penetrate to the membrane, if you operate 

on a case which you have had the charge of from the first, but must 

leave a thin scale of bone, as described in the process of sawing.